The role of physical design and informal communication

ABSTRACT
Graduate nurses experience a tremendous amount of stress as they transition
from a student to a practicing nurse. Much of this stress can be attributed to a feeling
of not having learned enough to function independently. While various formal
learning strategies, such as graduate nurse orientation programs, have been
implemented to solve this problem, not much attention has been paid to the potential
of informal opportunities for learning. This study examined how components of the
nursing unit ecosystem, including culture, organizational factors, technology, and
particularly the physical layout, influenced communication and opportunities for
informal learning, stress, and the gaining of nursing competencies during the formal
orienting period.
Five different data collection methods were used, including systematic
observation of communication and interaction patterns, a survey of organizational
climate and opportunities for informal learning, self-recorded blood pressure,
competency ratings, and focused interviews. The physical environment, particularly
backstage areas and clear sightlines within the nursing station, fostered opportunities
for informal communication and on-the-job learning; as well as relationships among
nurses that contributed to effective collaboration.
A combination of factors was found to influence the GN learning experience
including past experiences, unit culture, personal learning style, unit layout, and
interaction with staff. The gaining of competencies was not associated with a
reduction in stress, suggesting that other factors, particularly staffing levels, had more
of an impact on stress than nursing competencies per se. The extent to which other
social, organizational, and personal factors interact with staffing levels to produce
stress or mitigate its effects deserves further study.